The Quest for Perfection

It seems that Dr Bates attached great importance to the concept of perfection.

The Quest for Perfection

By Peter Mansfield

When Dr Bates entitled his book The Cure of Imperfect Eyesight..., and also used the alternate form Perfect Eyesight, he posed a problem which concerns every vision teacher. Can we be satisfied with achieving improvement, as opposed to deterioration, or is perfection (whatever that may mean) our only legitimate aim? And if so, how do we go about it?

It seems from his writings that Dr Bates attached great importance to the concept of perfection. Throughout his book and articles it occurs time and again: perfect vision, perfect memory, perfect imagination, perfect blackness, perfect relaxation, and so on. Clarifying Dr Bates' ideas on this subject and the questions they raise would seem worthwhile.

The emphasis on perfection has led many people who have used the Bates Method to feel disappointed that their vision has not become absolutely perfect even though they may have had great improvement, while others are discouraged from starting the process of improvement at all because the apparent demand is so daunting.

It is clear that the majority of optometrists are engaged in the quest for a rigid perfection: the essential creed of optometry is that there is a perfect prescription which will perfectly correct the optical error (which is, of course, assumed to be invariable) and give perfect vision at all times. Vision teachers are inclined to routinely disparage this point of view, while Dr Kaplan and others have provided clear evidence that it is misguided in various ways.

Many vision teachers, myself included, have taken a fairly soft approach, reasoning that any improvement is better than none, and that a large number of small steps may well lead us to that final goal. However, there are dangers and pitfalls with this way also.

The greatest difficulty, I feel, comes from most people's concept of perfection as necessarily implying something fixed, final, unalterable, an attitude which aligns with the usual optometrists' view.

Read in this light Dr Bates' statements do naturally convey the idea of a rigid, even oppressive approach.

Philosophically, however, it can be seen that perfection is not necessarily fixed at all, otherwise the expression 'perfect freedom' would be meaning less. Perfection, indeed, cannot exist apart from the thing that is to be perfected, and perfection only has meaning in terms of a thing's essential nature.

We know that vision is above all else about movement and change: Dr Bates constantly emphasises this point throughout his work, and it is amply supported by the entire literature of research on the nervous system. Even the technological ways of simulating the visual process demonstrate this: if there is no movement between the tape and heads of a video player there is no picture: the so called 'still' picture is nothing of the kind, but is achieved by causing the machine to run on the spot in a crude simulation of saccadic eye movement.

Perfect vision, therefore needs to be perfectly variable and mobile - in fact, perfectly imperfect; that is to say, imperfect to just the degree required by the design parameters of the eye and associated systems.

No aspect of this paradoxical business has caused so much trouble as the idea of perfect relaxation. I can remember one client declaring at the outset of a first interview that he could not possibly succeed with the Bates Method since, "It says in the book that you have to be perfectly relaxed and I'm not a relaxed person". It was quite useless for me to suggest that maybe being just a little more relaxed than at present might be a start and that the best way to begin would be to stop worrying about whether one was relaxed or not and take an interest in something outside. No, no: that wasn't perfect enough.

Presented in this way this extreme attitude appears quite humorous but it does raise a number of serious points. Having said all of the above, it remains true that vision usually becomes more stable as it improves and that very good vision is far more stable than poor vision which is in the process of improvement.

It is clear, moreover, that one can define 'normal vision' in functional, rather than statistical, terms, and that it is qualitatively different from all forms of faulty vision. The 'standard' of 20/20 is often held to be arbitrary, and even meaningless, it being clear that many people can get along perfectly well with less while many others can achieve far higher levels of acuity. While this is true as far as it goes, the fact is that there is a definite correspondence between the Snellen 20/20 standard and the optical resolution limit of individual cone cells, which indicates that Snellen's empirical calculation comes remarkably close to the most modern findings as to the acuity level to be expected of healthy eyes functioning normally in reasonable conditions. Higher acuities would normally require some form of 'software enhancement' in the brain, and lower levels would point to an abnormality in the eyes themselves, or in their use.

So, our idea of the perfection that we may wish to achieve needs to take all this on board.

Normal vision is inherently stable and self - regulating (homeostatic), whereas faulty vision is always prone to deteriorate. This means that, for any patient who has had normal vision and lost it, there has been a definite critical point at which there has been a change from normal to abnormal function, well before a loss of acuity has been apparent. This needs to be recognised by optical practitioners, who at present seem to think it sufficient to correct the acuity, without concerning themselves with function.

For a vision teacher, however, the question is, are we always to attempt to achieve normal eyesight (as we have now defined it)? Is it "OK" to have deficient eyesight if it is appropriate to your personality/situation or is feeling comfortable with 'deviant' eyesight, in itself pathological? Are we to aim for perfection, or to be content with encouraging improvement, and how far are the two possibilities compatible?

At first sight, there is no contradiction. After all, if the use and function are improved, the acuity will generally follow, to a greater or lesser extent. But we need to recognise that, however much improvement is gained, unless the vision is actually normal, we can assume that functional problems remain leading to a consequent tendency to deteriorate.

Take as an example the pupil who starts at -16D and improves to -8 / -5. This is fair progress by any standards, and far beyond what most medical people would regard as possible, but the fact remains, the vision is not normal, and if, instead of improving further, it shows a tendency to stabilise at this point we should ask ourselves, why?, with several supplementary questions which need searching answers before we should be content to say that the limit of improvement has been reached.

The likely reasons can be categorised as:

  • Functional
  • Mental/emotional
  • Physiological

Functional reasons

Although the function is improved, it is not normal. Although the techniques used have been helpful, they need refining and improving.

Difficulty arises especially if one has developed a habit of thinking of the way that exercises &co are carried out as 'right' which forms a barrier to further change. This sort of problem arises in many learning situations and is sometimes remedied by a change of teacher. This does not imply that the first teacher is bad or the new one any better, just that a change in the whole situation is sometimes helpful in refreshing the approach. It may be also that what at first appears to be a technical difficulty may have an emotional basis: e.g. there is some difficulty in surrendering control in order to allow something to happen spontaneously, and this attitude causes a restriction whatever practices are used or who ever is teaching them.

Mental / Emotional reasons

Fixed belief (e.g.: '1 can accept a degree of improvement but for it to become perfect is too big a strain on my reason'). Loss of motivation (It's good enough for now, 1 have other priorities ). Fear of Success (often based on childhood conditioning). Fear of Seeing (often based on unresolved internal difficulties).

Rational reservations can be overcome by reason, given time. The deeper emotional difficulties, leading to self-sabotage in various forms, will, again, affect all learning enterprises at some stage, but vision work tends to bring them out quite dramatically. The problem this poses can be a very important general learning opportunity, but I always have a bias against vision lessons turning into open-ended psychotherapy and anyway, the question is, if this person's vision is to be improved, how do we get beyond insightful discussion of this interesting difficulty and actually do something about it?

Physiological reasons

Pathological damage to nervous system, muscles or body of eye. Assumed inherent fault in shape of eye. Loss of flexibility from age &co.

My bias is always that a physiological basis or limitation to a problem remains to be proved. A nerve pathway may or may not be damaged, but if the function responds to stimulus it can be worked with. An eyeball may or may not be permanently elongated after years of high myopia but if the refraction consistently improves one cannot assume a physical limit.

However, it may be that there are degrees of physiological damage or abnormality which prevent the restoration of normal function or at least make it very difficult. The question is then, does one continue to strive to normalise, or work on the basis of supporting impaired function; and how on earth is one to decide?

The broader question underlying all of this is whether we accept that different people see differently and base expectations around that, or whether, barring pathological physical damage, we assume that all healthy people should exhibit clear and well balanced vision?

I would support the latter view. While we can speak in understanding terms of a 'preference' for poor vision as a healthy reaction to an unhealthy situation it is clear that this is only tenable in the short term. One way or another, the situation wants to be normalised as fast as possible. It can be seen that if the difficulty! limitation is basically functional the solution is straightforward - more work, different work, different teacher as indicated. If the problem is physiologically based then it has to be worked around but again the solutions are largely practical. Mental / emotional issues obviously pose the biggest challenge since there is not only the question of how to deal with them, but how far one will be permitted to do so, since the problems that affect vision are often those which fall in a 'protected area'.

In the end the decision as to how far to go rests with the client/pupil, but the teacher is in the position of adviser/guide and needs to be able to clearly assess and advise on what s/he sees as being in the pupil's best interests.

Needless to say, there may be a conflict between overt and covert motivations: most teachers know the client who expresses a strong desire to improve but sabotages it atevery point. Often, in fact, it is too strong a desire that is the problem: the perfectionist type of personality will have great difficulty in achieving the relaxation needed for the vision to change and will also be likely to put a lot of energy into criticising the teacher's efforts. And so on.

However, the teacher's role is to give as much help as possible. It may be true that the vision corresponds exactly to the personality type but it is no good noting this and doing nothing. These are difficult questions and you will notice that I am carefully not attempting to offer definitive answers. My main concern is that vision teachers, in taking a holistic and humanistic stance, may neglect the value and the validity of things that are measurable. A person - centred approach allows us to have flexible priorities, but the behaviour of light is no more negotiable than that of gravity so, while we can take a long term view and include views of the symptomatic significance of the visual difficulty, in the end, the improvement or lack of it, in the vision, is what counts.

It all comes back to finding the balance between trying and not trying, doing and not doing, being energetic and being passive and I think the point is that here we are coming very close to engaging with the nature of life itself; which is no doubt why everybody finds it so difficult, daunting and downright uncomfortable. Because, surely, perfection exists only as an idea and anybody who seriously expects to find it in the real world is suffering from a delusion and if they try to find it will only find unhappiness or inflict it on others.

At the same time, the idea is crucially important in giving direction to our efforts towards doing/being better, just as the stars, being out of reach, help us to steer courses to terrestrial destinations.

In practice, then, we should always aim as near perfection as possible - towards the absolute normalisation of vision by normalising function and helping to remove whatever obstacles we and our pupils find.

But in our way of going about this task there should be no obsessive perfectionism, just the infinite flexibility, patience and resourcefulness to keep us and our clients moving forward one step at a time with our eyes fixed . . . resting easily on that distant star. In that way, in time, we may even become perfect teachers.

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